It Is Democracy, Not Health-Care Reform, That Is Sick

As Josh Marshall says, we've reached a point in the health-care reform discussion where logic has fallen apart. Consider, for instance, Danielle Allen's op-ed this morning. Discussing the insistence of some that health-care reform will result in rationing and death panels, Allen chides those who respond with an accurate description of the legislation. "One can't answer them by saying: 'These policies won't ration; there will be no death panels,'" she writes. Instead, reformers must detail the "institutional checks that will prevent the emergence" of death panels and rationing.

In other words, the questions reformers have to answer is not "when did you stop beating your wife?" It's "what will prevent you from beating your wife?" Given that there is no such thing as a "death panel," nor any policy provision that would establish such a thing, it is hard to explain the institutional checks that would prevent a "death panel" from coming into being. When you have to explain why your bill won't create death panels, and what will make sure that it doesn't, you've pretty much lost the argument.

The fact that an idea as loony as death panels has found even the slightest purchase in the public consciousness shows how distant the minority feels from our democracy. Members of Congress are terrified of voter backlash and industry opposition. They are leaving virtually the entire health-care system untouched. They will scuttle the bill if a rural hospital in their district doesn't receive sufficient reimbursement or if a local device manufacturer is harmed. Yet there is a certain portion of the country that believes that Max Baucus and Mike Ross are willing to vote for death panels and defend them before their constituents in the following election.

What we're seeing here is not merely distrust in the House health-care reform bill. It's distrust in the political system. A healthy relationship does not require an explicit detailing of the "institutional checks" that will prevent one partner from beating or killing the other. In a healthy relationship, such madness is simply unthinkable. If it was not unthinkable, then no number of institutional checks could repair that relationship. Similarly, the relationship between the protesters and the government is not healthy. The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either. That claim is not about what is in this bill, or what government has done in Medicare and Medicaid and the VA. It is about what a certain slice of Americans think their government -- and by extension, their fellow citizens -- capable of.

"Similarly, the relationship between the protesters and the government is not healthy. The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either."

Ummm, would Speaker Pelosi claiming that protesters are Un-American be evidence? Would Krugman calling protesters racists be evidence? Would Union thugs putting a protester in the hospital be evidence?

This is why I do not believe that our political system is capable of controlling costs on universal healthcare. By any rational plan we would have better judgment on what to do for end of life care. A 99 year old woman should not get a pacemaker on the public dime. But anytime a politician comes out in favor of even the most reasonable cost control measures the opponents on the other side of the aisle will try and demonize them for doing so. When 15% of the public is covered through medicare the issue becomes totally politically untouchable- thats going to get orders of magnitude worse the more of the population that gets covered.

Whats shocking to me is that Ezra seems to understand that our government is totally broken yet still wants to trust our longterm healthcare to it.

1) Pelosi was not calling the protesters 'unAmerican', she was calling their tactics unAmerican (e.g., yelling/shouting toward disallowing honest debate and information flow).

2) Similarly, Krugman was specifically spotlighting the fact that no small number of protesters whose vociferous disagreement with the health care reform effort are not based in reality, but are instead related to the general truth that a black man is in the WH. (For what it's worth, I was born and bred in the south, and my personal experience suggests that there is truth to this contention.) Again, Krugman was not calling all protesters racist, but was instead opining on what may be driving some of them is not based on health care reform, but is based on a foundational dislike of the President's race.

3) If you care to read more into the SEIU 'thugs' story, you would recognize that this did not happen.

What is unAmerican is a desire to not engage in honest discourse on the merits, and to instead seek out information that supports your limited worldview and call it fact. Some of us are trying to further this country in the best interests of its founders. Others would have us devolve back into tribes.

To piggy back off of Terraformer, it's also worth pointing out that Krugman is, of course, the Senior Senator from NOWHERE, and members of the SEIU are Undersecretaries of DIDDLY SQUAT. So no, their actions just CAN'T be evidence of ANYTHING the government is capable of.

I suppose when the Government engages in torture, when it attempts to lock up people without trial (no matter who they are or where they are held), and when it purposely twists reality to support unjustified wars or, worse still, justified wars with unjustified means (thereby taking the short cut across the Constitution and public good will)...perhaps, right or wrong, the public has become accostumed to the Government doing the unthinkable.

Some would call if projection. If, on the right, they could justify their abuses to achieve their ends, why wouldn't they suppose that "we" are capable of similar abuses to justify ours.

This is what we get for not prosecuting war crimes at home, for allowing it to be framed as a "political" decision instead of a legal one. In a world where the Rule of Law becomes some fanciful historical buzzword and not a practice, of course people would actually believe that someday we might line up the old, the infirm, or the disabled and gun them down to save as many pieces of the pie for the healthy and wealthy.

It IS sick. We HAVE lost our way, but you shouldn't be surpised. We allowed CRAZY into the discussion the second we didn't stamp it out under 43.

God Help Us that we can't have a legitimate discussion about HOW to help the uninsured, underinsured, etc, and not for a "should we" discussion, but instead over lunacy such as death panels, socialism (does anyone even know what that word actually means anymore), fascism (we know noone knows that they word means today), and who started the hate talk.

I personally don't care who brought up being unAmerican or who is a Naxi or who is thug first. I want both side to grow the H up, cut it out, and look at reality.

I agree that there are better reasons to oppose the current congressional proposals than the prospect of "death panels". However, I think these death panels are actually a good idea. Most of a person's lifetime medical care dollars are spent in the last year of life. Maintaining an elderly person's life for a short period is certainly a noble luxury, but our country is running gigantic deficits as far as the eye can see, and these deficits are primarily driven by mandatory spending in Medicare, Social Security, and Medicaid. These 3 programs are already crowding out the rest of the federal budget, and they will soon crowd out the private economy as well. These three programs, and the deficits they are causing, threatens our prosperity, our national security, and our way of life. We should certainly consider whether we want to publicly subsidize certain expensive procedures that often only a very brief, often-painful, limited extension on life.

Is there any aspect of this phenomenon that doesn't directly indict the catastrophic failures of the national media? Madness is flourishing because the mind abhors an information vacuum. If there are no unbiased news outlets willing to fact check and call lies for what they are, then the job is left to partisan sites and it becomes a "he said/she said" situation in which few know the truth.

I wonder how much these protesters' fears of what "the government" might do (euthanizing Grandma, etc) are motivated by their beliefs about abortion. In my own conversations with several conservatives I often here "the evils" of abortion brought up as evidence of what the government is capable of...

Ezra,
Danielle Allen's suggestion isn't that unreasonable and has some grounding in the psychology of persuasion. It's impossible to prove a negative ("believe me, I don't beat my wife") but it is possible to identify why it's unlikely ("we've been happily married for 20 years, we have a good relationship, it's against the law, and if I ever did that I'd be in jail and it'd be all over the news").

So, instead of saying "there's no death panel in the bill, it's made up," Allen wants us to say something like: "There's no way that could ever happen because it'd be unconstitutional, illegal, there'd be stories about it actually happening all over the place, and ALL of us--especially those of us who want people to get more healthcare instead of less--would be up in arms. You would be, we would be, the whole country would be. And anyone trying to do something so terrible would be run out of town or thrown in jail because NOBODY in their right mind would allow such a thing."

I'm not so certain Allen's approach would make a huge difference. People who oppose health reform for these reasons are the kind of people who aren't inclined to support it or anything Democrats (especially popular black liberal Democrats) say or do. The reasons are lipstick gussying up some very unattractive underlying feelings.

But Allen's suggestion might make a difference on the margins with people who are already open to health reform but anxious about the brouhaha.

thank you so much for not losing your head, when all around you are losing theirs.

one could almot cry.
after watching some of the coverage of health care on television, over this past weekend...reading about the recent deaths of troops in afghanistan, pondering how mark sanford could still be in office, and now, thinking about the death of eunice kennedy shriver.
eunice kennedy shriver established the special olympics.
her husband, sargent shriver established the peace corps.
two human beings who believed in the potential of every person. that every person could make a difference.
and then i thought of their son-in-law.

luckily, the world goes on.
dermitt, up above, met a special person today.
i found a perfect swallowtail butterfly this morning.
life goes on.

"It's distrust in the political system." Or, "government isn't the solution; it's the problem." La morte main of Ronald Reagan still dominates all politics. Obama's election hasn't changed a thing. People are over the financial panic and fear change. They will buy into the scariest nightmares around to keep the status quo. And so it goes....

Precious, just precious, coming from the Washington Post. Handwringing about the dysfunctional misinformation of America. Look down the hall at your own editorial board, Ezra. What the hell are you doing associating yourself with this brand? And since you have decided to do so, please refrain from mock-helpless despair at a situation which your organization - and hence you - have had such a big hand in engendering.

Danielle Allen's suggestion reminded me of a friend of mine who had a son terrified of monsters, and who had a hard time falling asleep as a result.

She bought a can of Lysol, put a nice hand-written label saying 'Monster Spray' on it, showed it to the kid and went around the room at bedtime giving a spritz here and there, with a little extra under the bed.

Almost my entire life I've wondered about the explanation of how a very large part of the German people could have supported the goals of their government from the period 1933 (or so) to 1945 - which included invading country after country and stripping them of their wealth and citizens, as well as demonizing and destroying Jews, dissenting Christians, slavs of all types, homosexuals and communists/real socialists.

It didn't seem like they could claim they 'didn't know what was going on" and "they weren't involved".

Now I'm seeing how a nation can slide toward insanity when a persistent and ruthless minority decides to make a whole new set of social rules, and enforcing it with brownshirted volunteers that act with fanaticism and disregard for any norms of moral behavior. And they do this with the support of the national media that amplifies their hate and paranoia.

Yes, it can happen here. I see it becoming ever more present week by week. Complete lies presented as truth. Hate dished out under various coded and uncoded words and images. Resort to violence or threats to overwhelm the most reasonable people.

Democracy is a two-edged sword. It can be the vehicle for continued advancement of the common good. But it can also be directed into the ugliest mob rule that pursues fantasies and fears that are the most destructive side of human behavior.

Can this rush toward insane, destructive and immoral action be stopped? I'm not comforted when I hear it said that "it can't happen here". Because it is happening.

You should have included a couple of paragraphs at the end saying how the public option is a great idea because it would be pure and unsullied by politics and would compete on a level playing field with private insurers and thereby force them to compete.

Liberals are talking just like the 1960s and 1970s: America is a "sick society" just because it rejects the liberal social-engineering schemes. There's nothing wrong with America. There's a lot wrong with the liberal vision.

The polls show that ObamaCare is not selling with moderate and Independent voters. The town hall protests are irrelevant. What's relevant is that those moderate Dem "Blue Dog" congresspersons can't sell ObamaCare to their own constituents.

ObamaCare is NOT what we wanted. We wanted a program to control costs for the insured, NOT a trillion-dollar medical welfare program for the uninsured.

Let's remember: Obama LOST the white vote to McCain by 10 points. And Obama knows it. That's why ObamaCare spends a trillion dollars to help blacks and Hispanics get health care, even illegal immigrants.

The rest of us get nothing in hard dollars--nothing to control costs, according to the CBO. Instead, we have to fork over an additional trillion dollars, including $500 billion taken away from seniors on Medicare.

ObamaCare is a trillion dollar welfare program for minorities, paid for by the rest of us.

Bottom line: Liberalism was rejected in 1980. And older Americans are now remembering why.

Ezra,
This is why all your political expediency, pro co-op arguments over the past few years are crap. The president has tried and tried to extend a hand to the opposition so that we may repair a broken system together. And this is what we get in return; venal, stupid, greedy people and politicians being pimped by insurance companies et al to maintain the corrupt broken status quo. They would have attacked single-payer with the same vigorous stupidity. We should have started there.

We have become an Idiocracy.
http://en.wikipedia.org/wiki/Idiocracy

The last paragraph of this wonderful overview of the healthcare system by Julian Delasantellis in the Asia Times puts it about right:

http://www.atimes.com/atimes/Global_Economy/KG30Dj03.html

"Well, the American middle class is at present being voluntarily consumed so the rich can have their healthcare. Still, a great many of them oppose any Obama health plan; it's not easy to warn somebody that they're about to be eaten alive when you find them waiting patiently under the ketchup nozzle."

ostap666: Absolutely NOTHING run by the government is "pure and unsullied by politics."

For example, liberal Dem Senator Tom Harkin forced the National Institutes of Health to accept an Office of Alternative Medicine to investigate things like homeopathy and other medical quackery, which Harkin is particularly fond of.

The decisions and policies of the public option will be set by Congresscritters. Do YOU trust them?

"We wanted a program to control costs for the insured, NOT a trillion-dollar medical welfare program for the uninsured."

Who's "we"? When you mean "I", say it.

You wanted a program that would reduce your premiums, and couldn't care less about anyone else. And that's because you're an angry old white guy with a nice little bigoted streak pining for the days of Reagan.

"We wanted a program to control costs for the insured, NOT a trillion-dollar medical welfare program for the uninsured."

Why do we ONLY want controlled costs for the insured and not insurance for the uninsured?

I thought we wanted:
1. Insurance for everyone, both the people who are uninsured now, underinsured now, and those of us who might lose it in the future should we lose our jobs (etc)
2. Protections for the insured so whoever is controlling it (public/private/whatever) can't take it away when we need it most and leave us bankrupt.

Personally, I have no desire to bankrupt America to get univeral insurance, but don't we have to start with the idea that Universal insurance is necessary. Aren't we - the insured - alreayd paying something like $1100/ year in our own insurance premiums to cover the costs of emergency medical care for the unisured?

"Similarly, the relationship between the protesters and the government is not healthy. The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either."

The government not capable of madness...that would be funny if it wasn't so sad. Hasn't Ezra heard about the Tuskegee Experiment (done by the federal government) and how the head of it said: "The men's status did not warrant ethical debate. They were subjects, not patients; clinical material, not sick people."? Or how the Immigration Act of 1924 was designed by eugenicist to keep "inferior stock" out of the US? There are countless examples of the federal government going mad. People have been distrustful of the federal government under both Democrats and Republicans and for good reason. It's not to say that there will be "death panels," but for Ezra to assert there's no evidence that the feds would go mad is simply untrue. It is perfectly healthy not to trust the government.

The protesters have no problem with allowing the uninsured to die because they lack access to needed to care. Thus it isn't surprising that they are worried that other people, specifically a black President, would apply the same standard to them.

If they ever had any experience with a standard developed world health care system they'd see that while the budget for life-saving is never unlimited no one, not even the low cost single payer and single employer Brits, do what the fear mongers accuse universal healthcare of doing. But they don't, so they expect that our horrible system has to screw someone and they don't want it to be them.

Ditch the public option, and FOREVER give up the liberal dream of single-payer.

OK, maybe you could consider that to be TWO conditions"

that doesn't really seem to be accurate, but let's say it is...

Riddle me this: How are we protecting everyone without a public option?

You know what shocks me - and I admit I'm probably missing something fundamental - I don't get why corporate America is against single payer.

Right now, and I'm rounding, my employer pays something like $600/month to insure me and part of my family. I pay another $200/month pre-tax. I consider myself blessed with pretty good insurance, too. Not perfect, but so far so good.

I imagine my company would be thrilled to not have to pay that $7200/year for me, especially in this economy. Even if part of a public plan included my employer having to pay 1/2 half that as a "tax" (ditto for me) if I opted out of their insurance for the public option, they'd be saving $3600 on me annually.

I think it's kind of funny that all these people railing about "death panels" want to cling so expensively and painfully to this life even though Jesus is waiting to take them home to eternal life with Him.

Many years ago I read an analysis of vocal anti-abortion activists that said that many had marginal personalities and were afraid that if the line weren't held on abortion, they themselves would somehow be vulnerable to elimination. We saw this again during the Terry Schiavo mess--people who seemed to believe that her removal from life support was in some sense an existential threat to themselves.

This seems to be what is at work with many of the anti-health reform people, and why they are so susceptible to irrational arguments like the "death panels." They are so insecure, or have had their insecurities exacerbated by economic events, or Obama's election, or whatever, that they feel existentially threatened, and have fixed on health care as the cause. Death panels and the like are the manifestation of that fear.

That said, I don't know what can be done about this. Obama is very reassuring to many, but obviously not to these people. Seeing him competently in charge may just unhinge them more. The GOPers and Fox and industry people who are fanning this are really playing with fire. Even if someone doesn't get shot at one of these someone may have a stroke or heart attack from getting too worked up.

We are really reaping the whirlwind here after so much ignorance and misinformation has been sown. Too bad there are no reasonable Republicanbs left.

"The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either."

Unfortunately, there is evidence for this claim, both here and abroad. The US government specifically has made big policy mistakes in the past. I don't see this as an issue though. Uncivil, non-dialectic protests are very common in all western democratic countries, especially when they involve entitlements and redistribution. There is no american exceptionalism here.

The problem lies, I believe, with the fundamental communication mistakes the administration made in the early stages of the proposal. It wasn't very clear what the goals of the reforms were (insure everyone? Reduce costs? Improve service? Reduce arbitrary decisions of the insurers?) and the mechanisms adopted to meet these goals.

At this stage, the reform will be either declawed of its innovative elements, or will simply be defeated altogether.

I hope this will serve as an object lesson for the administration. Any further policy (e.g., financial regulation, tax reform) must be designed, controlled and IMPOSED on the congressional majority. Pelosi and Reid are good tacticians, but have proved themselves to be terrible policy-makers.

Obama is, willingly or not, making-or-breaking the reputation of the Democratic Party as an effective government party for the next 20 years.

Why is there no outcry about the real, actual, non-fantasy death panels that insurance companies are running as we speak?

Every decision to not cover treatment for a life threatening condition is an insurance company death panel. Every time a person with a pre-existing potentially fatal condition is denied coverage - that's a death panel pure and simple.

Why are conservatives afraid of phantom menaces when real ones are everywhere?

EZ: "What we're seeing here is not merely distrust in the House health-care reform bill. It's distrust in the political system. "

Boy, you're a slow learner. Many opponents of Dem. h/c reform plans dating back to well before Cintoncare have said that they are concerned about the ever-increasing role of government in the economy, the insurance markets and medicine.

"That claim is not about what is in this bill, or what government has done in Medicare and Medicaid and the VA."

Medicare is on course to be insolvent by 2019, if not before. One informed estimate puts the unfunded liability of the program at $85 *trillion*. How is irrational to oppose the creation of yet another public health insurance program when the Dem's apparent model is so "financially challenged" and our country is evermore indebted? If Obama can find hundreds of billions in savings from eliminating fraud and waste and unnecesary care as he claims, he should use them to shore up the current gov't programs and expand Medicaid coverage incrementally.

EZ: "It is about what a certain slice of Americans think their government -- and by extension, their fellow citizens -- capable of."

Based on the government's demonstrated inability to control costs in the Medicare and Medicaid programs I expect the planned cost control elements in the reforms will be largely unsuccessful in "bending the curve". Consequently, at some point in the near future I expect there will needs be rationing and/or taxes -- much higher even the Dems are currently planning. Indeed, Obama's finance guys are already floating trial balloons about breaking his campaign tax pledge.

The cost of the Medicare program itself overshot it's original budget projections by over 900% within its first couple of decades. So, you're correct Ezra, I do not trust the current administration or the Dems in Congress to do a good job. Hence my opposition.

Your question of whether we want to insure everyone is a complex one (perhaps intentionally so). There are many competing issues at play that must be considered before answering. First, our humanity leads us to wish to minimize suffering by all people in the world. Despite what liberals and media may tell you, conservatives are not monsters or Hitler who get a kick out of hurting people. So the answer is yes.

However, we probably have to confine ourselves to the geography of the United States, unless you sincerely want to also cover people in Papua New Guinea or Moldova as well. Now there are various groups of people here in the US: legal and illegal, the employed and unemployed, the sick and the healthy. So my answer is no, I don't want to insure everyone, such as illegals who cannot or will not pay for it, and those citizens who can pay for health coverage, but make a choice not to.

Let's assume that you still want everyone covered. Now, a substantial proportion of these people already are covered and relatively happy with their health care. Rather than overhauling the entire system with a single-payer, government-run program, maybe we should work out ways for people who cannot get coverage (the poor and the sick) for humanitarian reasons. Prudence dictates that nothing should be done for those able to obtain and afford health insurance, but opt not to. That should leaves us a much smaller fraction of people who should be provided some form of minimal coverage, which may be in the form of a government-run program like welfare.

So to answer your question, I would have to say yes, we should make sure that minimal coverage is available to all US citizens who cannot obtain it for themselves. Illegals may be provided life-saving treatments as mandated by law, but the government should play a stronger role in repatriating these people back to their homelands to be a burden on their own systems.

Hunter wrote;
"I don't get why corporate America is against single payer.

Right now, and I'm rounding, my employer pays something like $600/month to insure me and part of my family. I pay another $200/month pre-tax. I consider myself blessed with pretty good insurance, too. Not perfect, but so far so good.

I imagine my company would be thrilled to not have to pay that $7200/year for me, especially in this economy. Even if part of a public plan included my employer having to pay 1/2 half that as a "tax" (ditto for me) if I opted out of their insurance for the public option, they'd be saving $3600 on me annually."

I think your error here is not calculating out where the money would come from to pay for your health insurance. Another fundamental flaw is the assumption that the government coverage would automatically be cheaper than a private plan. First, there is no competition in a single-payer system and second, if we now have to cover everyone else, especially those who have no employer or income, won't that increase your share of the payment? The currently uninsured who are getting minimal emergeny coverage now would be able to get the same range of health care options as you do now - wouldn't this end up costing more and not less?

To clarify, yes, I am talking about American Citizens (and yes, people, that includes the President). I certaintly agree that, at the very least, providing adequate medical care and coverage for the rest of the world is a separate question, and, at the very most, should be taken up separately.

So what I'm asking is then this:

Without a public option - forget single payer for now - how are you covering those who cannot currently afford their own coverage?

jeirvine: It's not a phantom menace. Look what happened with Oregon's state health plan, as reported by ABC News:

Aug. 6, 2008 —

The news from Barbara Wagner's doctor was bad, but the rejection letter from her insurance company was crushing.

The 64-year-old Oregon woman, whose lung cancer had been in remission, learned the disease had returned and would likely kill her. Her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay.

What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.

"It was horrible," Wagner told ABCNews.com. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won't give you the medication to live."

Critics of Oregon's decade-old Death With Dignity Law -- the only one of its kind in the nation -- have been up in arms over the indignity of her unsigned rejection letter. Even those who support Oregon's liberal law were upset.

http://tinyurl.com/6h9dvh

Studies have shown that doctors are MORE likely to recommend end-of-life procedures (even assisted suicide), if cost is a major consideration.

Liberal bio-ethicists like Peter Singer have said flatly that to doctors, the lives of the elderly shouldn't be worth as much as the lives of the young, period.

In Massachusetts some years ago, Democrat candidate for governor John Silber addressed a meeting of seniors in which he literally said to them, "When you're overripe, it's time to go"--and make room for the young.

Liberals have been flirting with physician-assisted suicide for many years. It's tempting as a cost-saving measure, as the ABC News article suggests.

1. we keep calculating how much it cost the government EXCLUSIVELY to cover everyone, when it is clearly not a zero-sum game.

2. In that one of the more legitimate complaints I do hear from the GOP in Congress is that a public plan is unfair competition because its very volume with force lower costs, I think we can assume it will force lower costs.

Either that or we have to drop that argument from the Right side of the debate. You can't have it both way.

A clear sign of a failed politician is one who blames the people for using their own judgment and reaching a different conclusion than he did.

And the Democrats are reaching that point now.

In none of these "town hall" meetings have they opened up the forum to constructive suggestions from the audience as to what THEY would like health care to be like. Instead, they came there to deliver a message: "This is what it's gonna be, period. And if you disapprove, we're shutting this meeting down rather than listening to you":

http://www.youtube.com/watch?v=AoMNDdQ1_h0

Maybe they've forgotten that in our democratic society, Obama, Pelosi, Reid and all other elected officials work for the people, not the reverse. The people are sovereign.

The fear here is that a public option that would be made available to private employers would initially be seen as a cheaper alternative. Like the private health insurers themselves, they have to get to the bottom line and turn a profit. The federal government, which literally can print its own money, does not have to show a profit.

Let's use the mortgage crisis as an example: Government Supported Enterprises like Fannie Mae and Freddy Mac were able to make profits, but were still automatically bailed out by the government when things turned bad (and boy, did they!) When Congress had allowed them to loosen the standards to allow people who otherwise wouldn't qualify to get home loans anyway, the rest of the industry in the private side screamed and demanded the standards be lowered for them, too, which ended up as the disaster we have all come to know and love. The moral is that government may have the very best of intentions, but when you start fiddling with market forces, you could wind up making things worse.

That really doesn't directly answer your question, except to point out that a public option is ultimately bad for everyone. Perhaps by allocating funds for more government-run clinics, providing tax breaks to hospitals and physicians who do pro-bono work, or incentives to private insurers to offer lower cost options to the qualifying poor or those with preexisting conditions.

Frankly the whole notion of the government providing total care to everyone and paying for it by being more efficient does not make sense.

Why not? We do it for the military, for Congress, and for Medicare already?

I concede that public health insurance, properly run, would probably put Private Health insurance out of business eventually. Which is a shame, because we'll all miss how much they raked us over the coals for the last 60 years.

And how that is bad for everyone is beyond me.

Also...has anyone noticed that biggest opponents to Health Care reform all live in the states with the lowest level of Health care in this country?

In a way, it seems that the democratic process is actually being strenghtened here - albeit somewhat offensive to the more delicate classes. The spectacle of a citizen venting his anger at his elected representative -live and in person- has great appeal to me. One, many of these officials look visibly shaken as they are reminded that they must answer to the people they represent - not merely those who got them elected (lobbyists and supporters for a start). Two, these citizens may feel they have to shout and cause a stir in order not to be ignored. Three, in none of the accounts I have read was there an incident where an opponent to the Democrat plan became violent - only when the SEIU thugs were brought in did some protesters get beaten up. (Sorry about the charged word "thugs", but looking at these 300-lb behemoths shoving crowds of mainly senior citizens around - there's no other word)

The cries of "you work for us!" are surprisingly refreshing - it shows that the American people are finally starting to realize just who is in charge in a democracy.

The military is a special case - most of its members are younger and in good physical condition. I shudder to think that a national health care system will require senior citizens to get up at 0400, knock out a few hundred pushups and run 5 miles. Second - if you become really sick in the military, use illegal drugs, become grossly overweight, you are put out. Those who qualify can use the VA system, but that is a system that hardly could be used as a model that works (ask any vet).
The system in use for military families (Tricare) is essentially a private insurer that is paid by the Department of Defense and by the servicemember.

Don't even discuss the Congressional system - a system for 535 people, half of whom are millionaires anyway.

Finally, you admit a public option would eventually destroy the private insurance system, ending up as a single payer, which you also rejected as a potential disaster - who's having it both ways now?

See, that's not what I'm seeing. I'm seeing people making it impossible for Representatives actually answer the questions. The second they try to give responses, whether reasoned or not, they get shouted down. No one learns anything.

The thing that scares me most, is that those of us with coverage feel complacent. For one, most of us only have it because we have jobs that supply insurance, but only 59% of employers were covering there employees as of 2007. And, Private providers drop coverage all the time.

Think about it...sure most of us use our insurance to pay for regular doctor's visits and when we have the flu. Occassionally for relatively simple tests. But when things go wrong, really wrong...and on a long enough time line most of us will have to face that reality...more and more of us are losing coverage when we get Cancer or whatever.

Imagine if your home owners insurance cancelled coverage when your house burns down BEFORE they actually cover you.

That's what we're really talking about...not just helping those who need help now, but ensuring that we all stay insured.

I don't reject single payer as a disaster at all. I just recognize that Congress doesn't have enough of a backbone to do the right thing because a sub-set of American citizens don't really get the stakes.

Maybe the health and security of the American public doesn't need to be a profit industry.

"Discussing the insistence of some that health-care reform will result in rationing and death panels..."
-Ezra Klein

Of course there will be rationing; every good and service must be allocated either by prices in a free market economy, or centrally planned fiat as in a socialist system.

As for "death panels", regardless of what you want to call it, there will be government bureaucrats deciding how to ration health care. In Britain this is called QUALY or Qualtity Adjusted Life Years. In the U.S. it will be called something else but will be similar, as confirmed by Ezekiel Emanuel, Obama's chief medical advisor.

"The protesters believe the government capable of madness. There is no evidence for that claim..."
-Ezra Klein

There's plenty of evidence: Like every single policy that Obama has proposed which destroys wealth, curtails freedom, and drives jobs into the arms of our global competitors.

"What we're seeing here is not merely distrust in the House health-care reform bill. It's distrust in the political system. "
-Ezra Klein

Actually what we're seeing is distrust of Boss Obama and his Marxist minions.

AT LEAST this is a discussion. You haven't called me any names. You haven't taken my picture and put a little Hitler mustache on it.

I haven't called you an idiot or a redneck or a wingnut crazy.

Clearly we disagree, but we're talking.

What Ezra is saying here is that, right here, right now, we're the exception, and out there...the rehetoric is so bad and ugly, that the spirit of the democratic process, if not also the form, are in real danger.

I'm personally afraid of where this leads down the road, this furor and Fuhrer-comparisons. Next time, maybe someone doesn't just drop the concealed weapon at the town hall...maybe they use it.

I think you have a very different outlook on life in America - I see it as full of risks and opportunities to move ahead. That includes losing or changing health insurance as you move from one phase of life to another. Bad things happen and we each have to play the hand life deals us. I recognize there are others out there who want to feel safe all the time and don't mind the high taxes and limited freedoms that such a luxury demands. What's troublesome is when they say they want everyone else to be the same way.

The fact that we are all still having philosophical debates about who should be covered and why or why not indicates we are far from passing a plan that most can live with. That the President and Democrats in Congress were hellbent on passing a bill and its associated costs and consequences by early August may be the reason why so many Americans feel the frustration that they are not be represented. After all, if you caught me trying to paint your house yellow without asking you what color you wanted or even disussing whether the house needed painting at all, wouldn't you be a little miffed?

It is also amazing to me that we're still afraid of the Big Red Menace in 2009. didn't the cold war end 18 years ago.

We're throwing these words around as if the election of President Obama is synonymous with the end of the Constitution as we know it.

And in all seriousness...if we are truly worried about the President running roughshod over the Constitution, let's all of us make it clear that the Executive branch has real limitations and DEMAND the prosecution of the previous administration for their unConstitutional activities and get the precedent set now: Obey the Constitution or else!

all I can say to that john, is that I hope you never end up in a catastrophic medical situation without coverage. Sincerely. I wouldn't wish it on anyone.

Personally, I think some risks are too great.

Some risks threaten the whole system. (something we all should understand now)

A nation of debtors to the medical profession is a nation losing wealth and opportunity, a nation working off its past and not building on its future.

The truth is, health security is national security...and with fewer and fewer people insured every year, and fewer and fewer people able to pay their medical bills when they are uninsured, I don't really see how we can take that risk without admitted we're leaving most people behind.

I want to be a better neighbor than that. I want better neighbors than that.

Perversely, there's a little piece of me that wants the President's agenda to be fully implemented. I guess it stems from the principle that the people get the government they deserve (also known as the "I told you so" principle). And recognizing that there is always a risk that things could go horribly wrong, it begs a question of when and how does the citizenry do something about it? Do we sit back and wait until 2012 to vote Obama out? If changes start to be implemented with which an overwhelming percentage of Americans who disagree, should they be allowed to stand? Or should the people put pressure on their elected representatives to stop them? What if the elected officials refuse to listen? Do the citizens turn up the volume? Could this be where we are now?

I think what happens with the half billion dollars in new jet aircraft Congress ordered will be the first real test.

I can't say that I ever thought of the risk of losing health insurance as one of those fulfilling experiences that make the kaleidoscope of life worth living. Seriously, this is what we're reduced to? Saying that the American dream is all about getting bankrupted by health care costs because "that's just playing the hand you've been dealt"? I'm pretty sure America is about giving people limitless opportunities *no matter what kind of hand they were dealt in life*.

It never ceases to amaze that so many Americans look to big government for solutions, despite the consistent failure of economic central planning, throughout the world over the centuries.

Apparently for liberals, "progress" means moving away from the ideals of our founding fathers where millions of free individuals make millions of decisions about what is best, to a handful of politicians and bureaucrats who force everyone to pay taxes so they can buy votes and pay off cronies.

In the case of health care, the elite, ruling class won't even agree to have care for their own families dictated by the one-size-fits-all state-controlled system.

Their "utopian" plan is good enough for the peasants but not for the likes of Pelosi and Waxman, as they travel about the world in their multi-million dollar private jets at taxpayer expense.

The fundamental question that EZ raises is whether Americans do, or should, trust their government. It breaks down that for the most part liberals (like EZ) clearly do (except when its a conservative like Bush in charge), while conservatives for the most part do not (even when a conservative is in charge). Even Ronald Reagan as president constantly spoke of the healthy distrust Americans should have of their own government.

So that's where I stand - if the government were to take over health care, they would screw it up 5 ways to Sunday. And that's bad for everyone and worse than what we've got now.

"What part of "her last hope was a $4,000-a-month drug that her doctor prescribed for her, but the insurance company refused to pay" did you not notice when posting that story? Why no outrage at the insurance industry death panel?"
-jeirvine

Her "insurance company" was the state-run "Oregon Health Plan".

The woman was a "life-long smoker" who happened to get lung cancer. What a surprise.

Then the big bad pharmaceutical company, Genetech, stepped in and gave the woman the $4,000/month drug for free.

Now libs want to take away incentives for mind-boggling expensive, decade long, wonder drug development by pharmaceutical companies. You can bet more people will die and have their lives diminished as a result, although this will never be able to be proved, since the new drugs just won't exist.

I did not portray losing health insurance as a good thing - it's a bad thing, but it happens. Wanting the government to smooth over all the rough patches in life for you (and demanding everyone else have it, too) is not what I call the American way of life. Taking advantages of opportunities as they present themselves entails taking risks as well. It's no wonder this country has become so self-absorbed and complacent if that's the attitude we have adopted.

As I said, I never figured that having an insurance company deny me coverage, putting me at risk of losing everything to pay for treatment, was part of the wonder of life that made it worth living. I find it interesting -- and incomprehensible -- that you would view this sort of thing as "The American Way of Life." You seem to be more interested in defending the insurance companies' freedom than my freedom, and I think that is where you mistake lies.

The average voter is not a health care policy wonk. As a matter of fact, politics is about as appealing as a trip to the dentist for a root canal. They have neither the time or inclination to read through reams of information looking for a kernel of truth.

The only way a such a sweeping change could be done quickly is if the majority of Americans disliked the health care they presently have. That is not the case. Most Americans have fairly decent insurance and absolutely no reason to go along with any confusing alteration which they believe will cost them additional money or time.

Whether or not the 99 year old woman deserves a pacemaker depends on whether she is your grandmother, mother, yourself or an anonymous senior citizen living clear across the country. Politicians need to get end-of-life issues off the table completely because they are keeping the rest of the discussion off-topic. Every time a pundit or "medical ethicist" opens their mouth and asks people to consider the greater good, support for health care overhaul takes a nose-dive.

Let's all admit most voters are both selfish and ill-informed. This will not change any time soon. Those who want health care reform in this millenium need to start heavily reassuring their constituencies that "change" won't really be change for anyone who is happy with their status quo. The politicians have unsuccessfully tried to get around two crucial rules of life: "Keep it simple, stupid" and "If it's not broke, don't fix it."

Oh, come on, Ezra. Everybody knows these new funds will go right into the General Fund, and Congress will spend it all anyway.

We've been paying 15% more in Social Security since 1983, which was sold as building a surplus for the baby boomers. Our Congresscritters spent all of THAT, too. And now they're cutting $300 billion from Medicare just before those extra-paying boomers retire.

GENERAL FUND, Ezra.

Congress could spend those funds on anything they want, and you know it.

Libs are trying to convince the folks that if you only trust big government to take over, your health care will be free without any waiting or rationing, prices will go down, and the deficit will be reduced.

These libs, who apparently believe in the health care tooth fairy, are the same folks who laff at Christians for being superstitious.

People ask how would we pay for single payer, Medicare for All, say. Here's my usual reply. I can give more details:

Myth - "It will be very expensive to get good health to everyone."

Fact - Actually there's a way we can have better universal health care at no more than we are now paying (see 5. below). Here are the facts (cf. www.pnhp.org):

1. We waste $150 - $200 Billion a year on the high overhead of insurance companies.
2. We waste $200 - $300 Billion a year on doctors filling out forms for insurance companies.
3. I don't know the compliance cost of patients fighting with insurance companies, but it must also be in the 100's of Billions.
4. We pay the highest drug cost in the world to drug companies that spend twice as much on profit and three times as much on "marketing" as they spend on research. This is about another $100 Billion each year.
5. Because of the above, we could give Super Medicare (few limitations, no co-pays, no deductibles and complete drug, dental & mental coverage) to everyone at no more cost per person than we are now paying.

Other countries with single payer systems get better health care as measured by all the basic public health statistics and they do it at less than half the cost per person. If we build on our rotten system, we will get a health care system with rotten foundations.

1. Some people are just plain paranoid.
2. The distrust stems in some part from racism (e.g. the phrase "I never thought I'd live to see the day" when the U.S. had a dark-skinned president cuts both ways).
3. The nutjobs are a vocal, but fairly sizeable minority (e.g. the people who think that Palin has what it takes to be president right now -- a group where I suspect you'll find a fair number of Birthers and Deathers).

Ultimately though a narrow majority does support health care/health insurance reform, and in time that majority is more likely than not to grow given demographics trends (especially the ones connected to age). The real challenge is whether the change will happen fast enough to off-set some of the cost problems connected with rapidly increasing health care costs.

"The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either. That claim is not about what is in this bill, or what government has done in Medicare and Medicaid and the VA. It is about what a certain slice of Americans think their government -- and by extension, their fellow citizens -- capable of."

Well, Ezra, if you want an example, we've got a government that's perfectly capable of running a ruinous War on Drugs that's cost trillions of dollars, massively expanded and militarized the police throughout the country, locked up literally millions of citizens, severly impacted our foreign relations, enriched and empowered criminal organiztions and gangs of every stripe, while not really reducing either the demand or the supply of drugs to users. And it's supported wholeheartedly by just about every national-level political of both parties, and throughout the local and national bureaucracy.

Yeah, I'd call that madness.

Or, for another example. We've got a Congress filled with individuals who openly admit that they don't understand, and in many cases don't even try to understand, the laws they pass, and show no inclination to obey them themselves; and yet these individuals act aggrevied when the citisens who pay their salaries dare to question them or challenge them or, Heaven forfend, shout at them on occasion.

"Other countries with single payer systems get better health care as measured by all the basic public health statistics and they do it at less than half the cost per person. If we build on our rotten system, we will get a health care system with rotten foundations."
-lensch

It's always interesting how libs religiously embrace the idea that government will be more efficient at providing goods and services than the private sector, despite all evidence to the contrary.

Other countries have inferior health care and they wait far longer for it than in the U.S. Delaying diagnoses and treatment is life-threating.

If you don't like fighting with insurance companies now, just wait until your only option is fighting with a massive government bureaucracy.

In every discussion of reducing health care costs, why do libs always ignore the billions we shovel to the fat cat lawyers who sue doctors with bogus lawsuits?

If you think health care is expensive now, wait until the system is choked with bloated public employee unions and lawyers.

In a healthy relationship, the law does not give one party the authority to kidnap the other party, hold them against their will, and execute them if they fail to comply with its demands. Our relationship with the government is nothing like an interpersonal relationship between equals. We should exercise constant skepticism and scrutiny of the people and institutions to whom we give such awesome power.

So-called "compassionate conservatism", as practiced by the Bush Administration, was nothing more than big-government under conservative stewardship, as evidenced by the massive increase to Medicare, the No Child Left Behind Act and gimmickry aside, there is an argument that conservative policies are ultimately more compassionate than liberal ones, which create a culture of entitlement and dependency, which can be seen today in the health care debate.

John F. Kennedy famously challenged Americans to "ask not what your country can do for you; ask what you can do for your country" I would only add "and for yourself". That's my America.

"Other countries have inferior health care and they wait far longer for it than in the U.S. Delaying diagnoses and treatment is life-threating."

Well, I didn't know. It is truly amazing that since conditions are so bad that they live longer, their babies and mothers die less frequently at birth, the old people live longer, their babies are born heavier (a good indicator of health), etc., etc.,etc.
Must just be one of those paradoxes of life.

BTW maybe you can explain something to me. In other countries, when you need a treatment, you get it. Thousands in the US never get needed treatments since you cannot get most treatments (like cancer treatments) in an ER. Their wait times are infinite. My questions is how do you average in infinity?

I'm pretty sure that everyone remembers that episode of Star Trek where captain kirk beamed down to the planet where everyone was able to maintain their health insurance, but it turned out it caused all the people to live an enslaved, hedonistic life and never making any progress until he destroyed the massive policy and market regulations computer that was enslaving them. I think that teaches us some important lessons about how life is only worth living if we're willing to risk the whims of an insurance company revoking our coverage because we're too expensive to treat, don't you?

And "FreedomFan" is still spouting empty slogans. It must really be hard to start thinking for yourself once you're accustomed to being a parrot.

He clearly isn't free to look at the basic data that makes the US non-system of healthcare look like the embarrassment it is among developed nations. Perhaps he loves the Freedom to be bankrupted for treatment more than the freedom to live a life unencumbered by the fear of bankruptcy.

Not really. Longevity does not measure health care effectiveness, since it includes violent deaths by auto accidents and drug gang homocides.

Infant mortality also does not measure health care when you purposely ignore infants who die before age one; and I can't conceive the possible relevance of birth weight.

Health care effectiveness can be measured by mortality rates for cancer and various diseases, and the U.S. is consistently superior to almost every country with socialized medicine. But I suspect you already knew all this.

"Thousands in the US never get needed treatments since you cannot get most treatments (like cancer treatments) in an ER."
-lensch

Most folks don't go to the ER because they need cancer treatment.

Many people without insurance are illegal immigrants who help drive up the costs for legal citizens, so let them go back to their home countries and try to get cancer treatment there.

Another big chunk of folks without health insurance are young people who believe themselves to be indestructable and regardless are not keen on spending thousands for insurance when they know they can get it at the ER for free in an emergency. Cancer is rare among young folks.

Old citizens are already covered by MediCare; poor citizens are already covered by MediCaid.

"Health care effectiveness can be measured by mortality rates for cancer and various diseases, and the U.S. is consistently superior to almost every country with socialized medicine. But I suspect you already knew all this."

Here are mortality rates for all forms of cancer. Per 1000 people the US has 321.9, Australia 298.9, Canada 296.4, France 286.1, Austria 280, Sweden 268.2 Finland 255.4, and the UK 253.5.

Perhaps you live in an alternate universe.

BTW, half of the undocumented aliens have health insrance and you still haven't told me how to average in infinity.

Birth weight is a well known public health statistic. Look in any book on public health. Do you have have an hoc explanations for all the basic public health statistics?

Also I just gave cancer as an example of what you cannot get in an ER. Try and get a hip replacemnet or diabetes treatment in an ER. The fact is 22,000 people died last year because they lacked heath insurance (Urban Institue) and millions more suffered or went bankrupt. Tell me another country where this could happen.

"[A]ccording to a study published in the British medical journal The Lancet, the United States is at the top of the charts when it comes to surviving cancer. Among men, roughly 62.9 percent of those diagnosed with cancer survive for at least five years. The news is even better for women: the five year-survival rate is 66.3 percent, or two-thirds. The countries with the next best results are Iceland for men (61.8 percent) and Sweden for women (60.3 percent). Most countries with national health care fare far worse. For example, in Italy, 59.7 percent of men and 49.8 percent of women survive five years. In Spain, just 59 percent of men and 49.5 percent of women do. And in Great Britain, a dismal 44.8 percent of men and only a slightly better 52.7 percent of women live for five years after diagnosis."
-Policy Analysis
http://www.cato.org/pubs/pas/pa-613.pdf

Cpme on, you got to understand the difference betwen mortality rate (A good statistic which you referenced) and survivial rate (a terrible one).

I just posted the following on 538:

Lecture on survival rates: In order to be a survivor, the disease must first be detected, then you must survive for 5 years or whatever. If your disease is not detected, even though you live a long time, you are not counted. Many other countries have found that for some diseases you are better off not knowing, because once the disease is detected, there is a strong bias towards treatment which may not be the best thing.

Take prostate cancer. We routinely give PSA tests; other countries do not. We detect a lot more and treat a lot more. Our survival rates are better, but our mortality rates are not, and many men suffer as a result of the treatment. I have forbidden my physician from ordering a PSA test for me.

Also note that an emphasis on survival rates causes a lot more money to be spent which is good for physicians, but not so hot for the country.

So you were right the first time to talk about mortality rates, but wrong in what they told you. BTW if you ever need to know anything about statsitics, go to Cato and do the opposite.

So lensch, apparently you concede that the U.S. health care is far superior when it comes to your chances of surviving cancer, but that statistic is irrelevant because the U.S. also detects cancer sooner and it is somehow better not to know sooner. That is a laughable position.

I'll keep the U.S. system. Thanx anyway.

I submit that "mortality" rates are irrelevant because everyone has to die of something; higher cancer mortality rates probably are indicators of superior care.

"The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either."

Of course, when George W. Bush was President, there was no end to the perceived madness of the US Government - from the Left.

The concern over the "death panels" and the other regulations are not based on fantasy, but from actual policies that have resulted from similar experiments with government-run healthcare in other countries. Rationing of care is a fact in almost all countries with single-payer systems. Death panels (or some form of reducing end-of-life care) is the norm, not the exception in those systems.

Thus, a discussion about safeguards to make sure those policies do not result is a serious concern.

The 47 million uninsured is a bogus number, since most are 1) poor enough to qualify for government insurance already (but are apparently unwilling to sign up); 2) are rich enough (annual income >75k) to afford it if they need it; 3) are young and feel like insurance is a waste of $$; or 4) are here illegally and are locked out of signing up for existing programs.

The difference between lifespan in Canada, Europe, and America has less to do with health care payment systems and more to do with diet, exercise, and genes. Compare the lifespan of someone in Albania with that in Canada and you'll see that a Canadian only lives a few years longer. Once you get the hang of infant mortality and general hygiene down, the average lifespan falls to a natural mean.

Ezra - Attributing irrationality to your opponents is not a wise move as it blinds you to think only your way is the right way. The American people are smart enough to make choices regarding their health care and the way to pay for it.

Give people the freedom to live their life as they see fit. They don't need intervention from someone who gets their opinions through some journo-list echo chamber.

"So lensch, apparently you concede that the U.S. health care is far superior when it comes to your chances of surviving cancer"

No, no, no, we are better at dedecting cancer because we want to dedect it so we can treat it and make some money even if the patient would be better off not have it treated or even dedected. Your comment about everyome having to die of something is laughable.

Higher cancer mortality rates mean more people die of cancer per thousand. How you can conclude that means we have superior care boggles the mind.

"A healthy relationship does not require an explicit detailing of the 'institutional checks' that will prevent one partner from beating or killing the other."

What the heck is the U.S. Constitution all about, Ezra? Checks and balances are as American as apple pie.

I think you don't like the idea of addressing the subject of end of life bureaucracies because you are aware that it is a mathematical certainty that any socialized medicine scheme will eventually necessitate them.

The US reports live births for preemies who would go straight into the trash can in other countries. Last I looked, international guidelines did not count sub-kilogram births. Few survive, even here, but at least here they get worked on. If that was your baby, you'd want to deliver it here.

As for mothers, IIRC the US is brought down by a high population of mothers of African descent, a group which experiences high maternal mortality worldwide.

And of course, the suggestion that we should all forgo PSA tests is, as the other commenter noted, laughable.

Thank you for taking an interest in my Washington Post op ed of August 15th, “Health Reform’s Hearing Problem.” I fear that you have misread it.

It was written from the position of someone who supports health reform but who thinks that the Democrats could do a better job of dealing with the various arguments being thrown up against reform.

All health systems ration care. All health systems foster distinctive approaches to end-of-life issues. It is a mistake to pretend such issues do not exist. In response to a question about whether the proposed reforms will make our own health system worse in either area, Democrats should be able to explain the principles that might appropriately guide all of us in thinking about these issues.

I know that a fair number of people read and understood my op-ed in just this way.

I do not, as one blogger who picked up your post, Mr. Klein, wrote: “put forward the ‘death panel’ dishonesty.”

I support the health reform initiative presently before Congress. Like others I await more details. I worked very hard on the Obama campaign, both through financial donations to the maximum of my capacity and through six weeks of full-time volunteer work leading up to the Feb. 5th “Super Tuesday” primary. One of the reasons I did so was that I think reforming our health system is of critical importance.